Spontaneous epidural pneumocephalus.
A 20-year-old male presented with an extremely rare spontaneous epidural pneumocephalus which was successfully treated by a single neurosurgical intervention. The patient had a habit of nose blowing and a 1-year history of progressive headache and nausea. Cranial computed tomography (CT) revealed a 2 x 7 cm right temporo-occipital epidural pneumocephalus with extensive hyperpneumatization of the mastoid cells. Right temporo-occipital craniotomy with a right superficial temporal artery and vein flap repair resulted in radiographic resolution of the pneumocephalus, and he remained neurologically free of symptoms at 1-year follow-up examination. Early identification and monitoring of symptomatic pneumocephalus followed by decompression and prevention of infection via closure of the bone defect can avoid possible serious consequences. The underlying mechanisms may involve a congenital petrous bone defect and a ball-valve effect due to excessive nose blowing in our case.
Tucker
Adam
A
Department of Neurological Surgery, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Hyogo, Japan. tucker@nk-hospital.or.jp
Miyake
Hiroji
H
Tsuji
Masao
M
Ukita
Tohru
T
Nishihara
Kentaro
K
Ito
Seiko
S
Ohmura
Takehisa
T
D000328:Adult; D003399:Craniotomy; D004824:Epidural Space / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D006261:Headache / Q000209:etiology; D006801:Humans; D019586:Intracranial Hypertension / Q000150:complications / Q000209:etiology; D008297:Male; D008416:Mastoid / Q000000981:diagnostic imaging / Q000473:pathology; D010579:Petrous Bone / Q000000981:diagnostic imaging / Q000473:pathology; D011007:Pneumocephalus / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology*; D013524:Surgical Flaps; D013699:Temporal Arteries / Q000033:anatomy & histology / Q000601:surgery; D013701:Temporal Bone / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome